2014 Snapshot Summary

This section is a summary of various benefits offered by Santa Clara University to its benefits eligible faculty and staff for 2014. Each benefits summary is meant only to provide a brief overview of the covered services. Complete information on covered services, exclusions, and plan limitations may be obtained by contacting the Provider directly.

Blue Cross HMO Plus Option Medical Plan

Description: Select a Primary Care Physician (PCP) from a group of physicians who are a part of the Blue Cross network (see www.bluecrossca.com for the directory of participating physicians). Your PCP will coordinate all of your care. Therefore, specialty care must be referred by your PCP. A PCP is defined as an internist, general practitioner, family practitioner and pediatrician. All non-emergency treatment must be received by one of these providers. In exchange for higher per pay period premiums, you pay less money out-of-pocket when you receive services.

This is a summary of the benefits provided. Once enrolled, members will receive a Combined Evidence of Coverage and Disclosure Form (PDF), which explains the exclusions and limitations, as well as the full range of covered services of the plan, in detail. Under all circumstances, policy form and wording take precedence over information contained in this summary.

See Also

The Blue Cross HMO Plus Option - Summary of Benefits PDF may not display properly in some browsers. If you are experiencing trouble viewing this PDF, please download the PDF and open it in Adobe Reader.

Blue Cross HMO Standard Option Medical Plan

Description: Select a Primary Care Physician (PCP) from a group of physicians who are a part of the Blue Cross network (see www.bluecrossca.com for the directory of participating physicians). Your PCP will coordinate all of your care. Therefore, specialty care must be referred by your PCP. A PCP is defined as an internist, general practitioner, family practitioner and pediatrician. All non-emergency treatment must be received by one of these providers. In exchange for lower per pay period premiums, you pay more money out-of-pocket when you receive services.

This is a summary of the benefits provided. Once enrolled, members will receive a Combined Evidence of Coverage and Disclosure Form (PDF), which explains the exclusions and limitations, as well as the full range of covered services of the plan, in detail. Under all circumstances, policy form and wording take precedence over information contained in this summary.

See Also

The Blue Cross HMO Standard Option - Summary of Benefits PDF may not display properly in some browsers. If you are experiencing trouble viewing this PDF, please download the PDF and open it in Adobe Reader.

Blue Cross Lumenos* HSA (Compatible) High Deductible PPO Medical Plan

Description: The high deductible PPO Medical Plan requires members to meet the deductible before the Plan will reimburse for any treatment, except routine and preventative care. The deductible is waived for routine and preventative care, and the treatment is covered 100%. For all other treatment, members must meet their deductible before the Plan pays for care. Participants may use the money saved in a Health Savings Account (HSA) to meet that deductible. The HSA allows members to designate a pre-tax dollar amount they wish to contribute to their HSA, and they may use that money to pay for medical care, prescriptions and other eligible medical expenses. The High Deductible PPO Plan includes traditional health coverage, similar to a typical health plan that protects members against large medical expenses after participants meet their deductible. See below for more info.

* Lumenos plans are wholly owned by Blue Cross.

General Information

PPO

Non-PPO

Annual Deductible

Individual: $2,500
Family $5,000

Annual Out-of-Pocket Maximum (includes deductible)

Individual: $3,500
Family: $7,000

Individual: $7,000
Family: $14,000

Lifetime Maximum Benefit

Unlimited

Medical Benefits

PPO

Non-PPO

Doctor Office Visits

No copay

Covered at 70%

Routine Physical Exam

No copay (Deductible Waived)

Covered at 70%

Adult Preventive Services

No copay (deductible waived)

After deductible is met: Covered at 70% subject to a copay schedule of $10 Generic, $30 Brand, and $50 Non-Formulary.

Prescription Drugs Copays: Pharmacy (30-day Supply)1

After deductible is met: prescriptions will be covered subject to a copay schedule of $10 Generic, $30 Brand, and $50 Non-Formulary.

Prescriptions that fall under Specialty Pharmacy will be covered at 70% after a $150 copay for a 30 day supply (currently a 90 day supply is available for specialty pharmacy).

After deductible is met: Covered at 70% subject to a copay schedule of $10 Generic, $30 Brand, and $50 Non-Formulary.

Prescriptions that fall under Specialty Pharmacy will be covered at 70% after a $150 copay for a 30 day supply (currently a 90 day supply is available for specialty pharmacy).

Prescription Drugs Copays: Mail Order (90-day Supply)1

After deductible is met: prescriptions will be covered subject to a copay schedule of $10 Generic, $30 Brand, and $50 Non-Formulary.

Not applicable

Physical Therapy, Chiropractic Care

After deductible is met: No copay; limited to 24 visits per calendar year

After deductible is met: Covered at 70%; benefit limited to $25 per visit; per calendar year

Diagnostic X-ray/Lab

After deductible is met: No copay

After deductible is met: Covered at 70%

Hospital Benefits

PPO

Non-PPO

Room & Board

After deductible is met: No copay

After deductible is met: Covered at 70%

Surgeon's Fees

After deductible is met: No copay

After deductible is met: Covered at 70%

Maternity/Delivery

After deductible is met: No copay

After deductible is met: Covered at 70%

Emergency Room

After deductible is met: No copay

After deductible is met: No copay

Out-Patient Services

After deductible is met: No copay

After deductible is met: Covered at 70%

In-Patient Services

After deductible is met: No copay

After deductible is met: Covered at 70%

1 Until the calendar year deductible is satisfied, the insured person pays the prescription drug covered expense, and not the copays listed.

Once enrolled, members will receive a Combined Evidence of Coverage and Disclosure Form (PDF) which explains the exclusions and limitations, as well as the full range of covered services of the plan, in detail. Under all circumstances, policy form and wording take precedence over information contained in this summary.

The Blue Cross Lumenos HSA (Compatible) High Deductible PPO - Summary of Benefits PDF may not display properly in some browsers. If you are experiencing trouble viewing this PDF, please download the PDF and open it in Adobe Reader.

Blue Cross Lumenos* HIA PPO Medical Plan

Description: The Blue Cross Health Incentive Account (HIA) Plan offers all the benefits of a traditional health plan plus a chance to earn health care dollars by taking steps that can achieve better health. The Plan includes an incentive account which gives members health care dollars to help offset out-of-pocket health expenses.

If participants complete the following program, they will earn HIA credits to reduce out-of-pocket expenses. Unused HIA dollars roll over year-to year.

Program

Credit

Complete Health Assessment Online

$50/adult/year

Enroll in Health Coach Program

$100/person/year

Graduate for Health Coach Program

$200/person/year

Complete Smoking Cessation Program

$50/person/lifetime

Complete Weight Management Program

$50/person/lifetime

*Lumenos plans are wholly owned by Blue Cross.

General Information

PPO

Non-PPO

Annual Deductible

Individual: $500
Family $1,000

Annual Out-of-Pocket Maximum (includes deductible)

Individual: $2,500
Family: $5,000

Individual: $5,000
Family: $10,000

Lifetime Maximum Benefit

Unlimited

Medical Benefits

PPO

Non-PPO

Doctor Office Visits

Covered at 90%

Covered at 70%

Routine Physical Exam

No copay (Deductible Waived)

Covered at 70%

Well-Baby Care

No copay (Deductible Waived)

Covered at 70%

Adult Preventive Services

(Deductible Waived) Covered at 100%

(Deductible Waived) Covered at 70%

Prescription Drugs Copays: Pharmacy (30-day Supply)1

After deductible is met: Covered at 80% subject to a copay schedule of $10 Generic, $30 Brand, and $50 Non-Formulary.

After deductible is met: Covered at 70% subject to a copay schedule of $10 Generic, $30 Brand, and $50 Non-Formulary.

Prescription Drugs Copays: Mail Order (90-day Supply)1

After deductible is met: Covered at 80% subject to a copay schedule of $10 Generic, $30 Brand, and $50 Non-Formulary.

Not applicable

Physical Therapy, Chiropractic Care

After deductible is met: Covered at 90%; limited to 24 visits per calendar year

After deductible is met: Covered at 70%; benefit limited to $25 per visit; limited to 24 visits per calendar year

Diagnostic X-ray/Lab

After deductible is met: Covered at 90%

After deductible is met: Covered at 70%; limited to $25 per visit

Hospital Benefits

PPO

Non-PPO

Room & Board

After deductible is met: Covered at 90%

After deductible is met: Covered at 70%

Surgeon's Fees

After deductible is met: Covered at 90%

After deductible is met: Covered at 70%

Maternity/Delivery

After deductible is met: Covered at 90%

After deductible is met: Covered at 70%

Emergency Room

After deductible is met: Covered at 90% (copay waived if admitted)

After deductible is met: Covered at 70% (copay waived if admitted)

Out-Patient Services

After deductible is met: Covered at 90%

After deductible is met: Covered at 70%

In-Patient Services

After deductible is met: Covered at 90%

After deductible is met: Covered at 70%

Vision Benefits

PPO

Non-PPO

Vision Benefit provided through Vision Service Plan

See Blue View Vision summary below for covered benefits.

Health Rewards
If you do this:

You can earn this in your HIA:

Complete Health Assessment Online

$50

Enroll in the Personal Health Coach Program

$100

Graduate from the Personal Health Coach Program

$200

Complete Smoking Cessation Program

$50

Complete Weight Management Program

$50

1 Until the calendar year deductible is satisfied, the insured person pays the prescription drug covered expense, and not the copays listed.

Once enrolled, members will receive a Combined Evidence of Coverage and Disclosure Form (PDF), which explains the exclusions and limitations, as well as the full range of covered services of the plan, in detail. Under all circumstances, policy form and wording take precedence over information contained in this summary.

The Blue Cross Lumenos HIA PPO - Summary of Benefits PDF may not display properly in some browsers. If you are experiencing trouble viewing this PDF, please download the PDF and open it in Adobe Reader.

Kaiser Permanente HMO Plus Option Medical Plan

Description: Members enrolled in the Kaiser Permanente HMO, receive all medical treatment from Kaiser physicians, facilities and pharmacies. The Plan does not cover services rendered by providers outside of Kaiser unless participants require immediate medical care for an urgent medical condition and are outside the Kaiser service area. There are no deductibles or claim forms. Kaiser Permanente covers most services at 100% after participants pay a copayment. In exchange for higher per pay period premiums, you pay less money out-of-pocket when you receive services.

Benefit

Coverage/Copay

Deductible

None

Inpatient Hospital

100% coverage after $250 copay

Physician Office Visits

$20 copay

Routine Physical Exams

No copay

Routine GYN Exams

No copay

Maternity Care Office Visits

Prenatal and 1st postpartum - no copay;

Well-Baby Care

No copay

Prescription Drugs

$10 copay generic
$25 copay for non-generic formulary brand

Emergency Room (waived if admitted)

$50 copay, waived if hospitalized

Chiropractic

$15 copay (limited to 30 visits per year)

Mental Health (Outpatient)*

$20 copay

Mental Health (Inpatient)

100% coverage after $250 copay

Vision Benefit (Exam)

$20 copay; no maximum

Vision Benefit (Lenses, Frames, and Contacts)

$175 allowance every 24 months

*SCU provides additional mental health benefits through its Employee Assistance Program (EAP) and Mental Health Benefits Program with United Behavioral Health (UBH).

This is a summary of the benefits provided. Please refer to Kaiser Permanente Traditional Plan Evidence of Coverage, Chiropractic Care and Principal Benefits - for non-union members only (PDF) for plan details, exclusions and limitations.

Kaiser Permanente HMO Standard Option Medical Plan

Description: Members enrolled in the Kaiser Permanente HMO, receive all medical treatment from Kaiser physicians, facilities and pharmacies. The Plan does not cover services rendered by providers outside of Kaiser unless participants require immediate medical care for an urgent medical condition and are outside the Kaiser service area. There are no deductibles or claim forms. Kaiser Permanente covers most services at 100% after participants pay a copayment. In exchange for lower per pay period premiums, you pay more money out-of-pocket when you receive services.

Benefit

Coverage/Copay

Deductible

None

Inpatient Hospital

$500 copay per day

Physician Office Visits

$30 copay

Routine Physical Exams

No copay

Routine GYN Exams

No copay

Maternity Care Office Visits

Prenatal and 1st postpartum - no copay;

Well-Baby Care

No copay

Prescription Drugs

$10 copay generic
$25 copay for non-generic formulary brand

Emergency Room (waived if admitted)

$150 copay, waived if hospitalized

Chiropractic

$15 copay (limited to 30 visits per year)

Mental Health (Outpatient)*

$30 copay

Mental Health (Inpatient Hospital)

$500 copay per day

Vision Benefit (Exam)

$30 copay; no maximum

Vision Benefit (Lenses, Frames, and Contacts)

$175 allowance every 24 months

*SCU provides additional mental health benefits through its Employee Assisitance Program (EAP) and Mental Health Benefits Program with United Behavioral Health (UBH).

This is a summary of the benefits provided. Once enrolled, members will receive a Combined Evidence of Coverage and Disclosure Form. See also Chiropractic Care and Principal Benefits - for non-union members only (PDF) for plan details, exclusions and limitations.

Health & Wellness tools

Assess your wellbeing and receive a personal wellbeing report with tips for living better

Make a change with self-help programs for stress, weight management, nutrition, fitness and tobacco cessation

Take advantage of interactive e-learning programs

Find articles and videos on emotional health, physical health and making healthy choices

Plan Design

Benefit

In-Network/Pre-Certified

Non-Network

Employee Assistance Program

100% coverage, up to 8 visits, per instance

None

Note

It is recommended that you confirm, with MHN, your copay amount prior to your visit with a practitioner.

Confidentiality is maintained within all Federal and State guidelines. Records can not be released without your written consent.

Program Highlights

All services must be pre-certified.

Intermediate levels of care, such as partial hospitalization, residential, day treatment and structure outpatient services may be used in lieu of inpatient care with MHN approval. Intermediate care coverage is based on the inpatient benefit and accumulates toward the inpatient benefit maximum.

All employees and dependents are eligible for the EAP benefit.

Frequently Asked Questions

Why Should I use these benefits?

Your Employee Assistance Program (EAP) benefit is available to assist you with many work related and personal issues, from advice about a financial question to dealing with a stressful work situation to overcoming a serious emotional problem.

How do I access my MHN benefits?

MHN is open 7 days a week, 24 hours a day. Just call 1-800-535-4985 when you are ready. You will speak with a Masters level EAP Specialist who will assess the situation and give you the name and number of a network provider near you who specializes in your particular issue.

Is the program confidential?

Yes. Without your written consent, records cannot be released. Confidentiality is maintained according to all Federal and State guidelines.

What services does my EAP offer?

Your EAP provides free, face-to-face counseling for personal issues and work-related concerns that can be resolved in a brief time period. In addition, your EAP can refer you to a wide range of services, including legal, financial, family mediation and community resources.

What happens when I use up my eight EAP visits?

If you still need ongoing care after you have used your eight free sessions, you will need to contact your medical provider. You will be authorized another eight EAP visits in the next calendar year.

Tuition Remission Program

Scope

Courses taught by SCU Faculty, exclusive of ancillary or continuing education courses, the Executive MBA and Accelerated MBA programs, laboratory, application, service and other incidental fees.

Note: Either the FACHEX or Tuition Exchange Program may be used in place of SCU Tuition Remission Program for dependent children of eligible faculty and staff. See the FACHEX Information or Tuition Exchange pages for additional information and links to participating institutions.

Eligibility

Tenured, tenure track and senior lecturer faculty must teach a minimum of 6 courses per academic year to receive the full tuition remission benefit.

All regular staff working 30 hours or more per week.

Employees working less than the eligibility limits above will receive tuition remission on a pro-rated basis, and the benefit is not available to their dependents.

Spouses of eligible faculty and staff

Children of eligible faculty and staff who are

under age 25 for Undergraduate Courses

under age 30 for Graduate Courses

Note: Employees and their dependents are considered students for all issues related to admissions, registration, add/drop refund policy, fee assessment, financial holds, program minimum requirements, or related matters. Spouses or children must be enrolled as matriculating students.

Benefit

Faculty/Staff

Full benefit after 1 year of employment

Undergraduate and/or Graduate Courses

2 undergraduate courses per quarter or 6 graduate units per quarter/semester during academic year

1 undergraduate course or 3 graduate units per summer

Family Members

100% after faculty/staff member completes 3 years of continuous employment and meets eligibility requirements.

Choice of courses toward one Undergraduate or courses toward one Graduate Degree

Payment Process

Each participant is required to complete a new Intent for Register form (PDF) at the beginning of each academic year.

Tuition remission will be applied as a credit to the student's account. The tuition amount will be credited after the official add/drop period has ended, and all revisions to course load and/or tuition charges have been processed by Student Records. This is an effort to accurately credit each participant's account should a change to course load occur.

Tuition charges and course loads for participants are verified in PeopleSoft by Human Resources directly. As a result, you no longer need to submit your billing statement to Human Resources.

Note: Graduate level tuition remission is considered taxable income to the faculty/staff member. The tuition will be added to gross pay, as taxable income, in the quarter that tuition is received. More information may be obtained by contacting the Human Resources Service Desk at (408)554-4392 or by viewing Policy 609 - Education Benefits in the Staff Policy Manual.

Life/AD&D Insurance

Living Benefit: A 80% benefit to maximum of $56,000; based on diagnosed terminal illness with expected duration of twelve months or less. More information on Living Benefit (PDF 144KB)

Travel Accident AD&D (Cigna Life Insurance)

Faculty, Staff and Union: $100,000

In the event of your accidental death due to traveling on SCU business, your beneficiary will receive a benefits amount equal to $100,000. Partial benefits are payable to you if you lose your eyesight or a limb as the result of an accident. More information on Cigna Business Travel Insurance (PDF 660KB)

More information regarding the Santa Clara University Employee Term Life, Accidental Death and Dismemberment and Dependents Term Life coverage:

Cancer Protection Plans

American Fidelity offers several products that can help with the expenses that may not be covered by other insurance, including cancer screenings. Benefits and rates vary depending on the plan chosen.

Cancer Expense Insurance Policy

American Fidelity will pay the actual charges incurred by a Covered Person for treatment of Cancer, Leukemia or Hodgkin's Disease, subject to certain maximum amounts.

Highlights

Guaranteed renewable for life ... Coverage cannot be cancelled

Pays benefits directly to you, the insured

Pays regardless of any other health coverage

A choice of products with a variety of benefits

Portable - you can take this coverage with you when you leave employment

Cancer Indemnity Insurance Policy

American Fidelity will pay a one time Initial Diagnosis (first time in the person's lifetime) benefit amount of $10,000, $25,000 or $50,000, depending on the amount selected at the time of application, if a covered person is pathologically or clinically diagnosed as having any internal cancer.

Highlights

Guaranteed renewable for life ... Coverage cannot be cancelled

Pays benefits directly to you, the insured

Pays regardless of any other health coverage

A choice of benefit amounts

$75 annual preventive care benefit

Portable - you can take this coverage with you when you leave employment

Note: Both policies have limitations and are inappropriate for people who are eligible for Medicaid.

Long-Term Care

This is a post-tax, insurance program designed to provide benefits to assist with the cost of Nursing Home and/or Community Based Care required because an insured has a Qualified Impairment.

Long-Term Care Benefits

Option A

Option B

Option C

Daily benefit for nursing home care

$100

$140

$180

Daily benefit for community based care

$50

$70

$90

Corresponding lifetime maximum benefit

$200,000

$280,000

$360,000

Waiting Period Before Benefits Begin

For nursing home care: 60 days of nursing home care

For community based care: 15 days of community based care

Respite Benefit

Your plan will pay the daily respite benefit for nursing home care or the daily respite benefit for community based care up to 14 days per year. The respite benefit for community based care includes companion care and is payable in addition to the community based care benefit.

Short-Term Disability

Benefit

60% of gross predisability earnings

Maximum Weekly Benefit

$1,103

Minimum Weekly Benefit

$50

Benefit Waiting Period

7 days

Integration

Integrated with sick leave

See Also

Plan Document, Self-Insured Voluntary & Paid Family Leave Benefit Plan for California Employees of Santa Clara University for Disability and Family Leaves Commencing on or after January 1, 2010